Provider Demographics
NPI:1174681258
Name:SMITH, DONNA CORINNE (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:CORINNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:CORINNE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:163 MEDICAL PARK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-6790
Practice Address - Country:US
Practice Address - Phone:919-742-6032
Practice Address - Fax:919-663-3018
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2809216Medicare ID - Type Unspecified
NCP94782Medicare UPIN